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Published on: March 27, 2018
The Disparities of Coronary Artery Bypass Grafting Surgery Outcomes by Insurance Status: A Retrospective Cohort
Timothy M Connolly1, Robert S White1, Dahniel L Sastow2
1Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, Box 124, New York, NY, 10065, USA.
Insights
Patients with Medicaid insurance face significantly higher risks of mortality and complications after coronary artery bypass grafting (CABG) surgery compared to those with private insurance. This highlights insurance status as a key factor impacting CABG outcomes.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Health Economics
Background:
- Coronary artery bypass grafting (CABG) is a standard treatment for complex coronary artery disease.
- Social determinants of health, such as insurance status, influence surgical outcomes.
- Understanding the impact of primary payer status on CABG patients is crucial.
Purpose of the Study:
- To investigate the association between insurance status, specifically Medicaid, and postoperative outcomes in isolated CABG patients.
- To identify if Medicaid insurance is an independent predictor of adverse events following CABG.
Main Methods:
- Retrospective analysis of State Inpatient Databases (2007-2014) from five states.
- Inclusion of isolated CABG patients aged 18 years and older.
- Multivariate regression analysis to determine adjusted odds ratios for various outcomes by insurance status.
Main Results:
- Patients with Medicaid or Uninsured status had significantly higher adjusted odds of postsurgical inpatient mortality compared to Private Insurance.
- Medicaid patients showed the highest adjusted odds for 30-day (OR 1.52) and 90-day (OR 1.53) readmissions.
- Medicaid insurance was associated with increased postsurgical complications, longer length of stay, and higher total hospital charges.
Conclusions:
- Medicaid insurance is independently associated with worse postoperative outcomes after isolated CABG.
- Payer status, particularly Medicaid, is a significant predictor of perioperative risks in CABG surgery.
- Further research is warranted to elucidate the underlying reasons for these disparities in outcomes.
Background:
Coronary artery bypass grafting (CABG) surgery is the gold standard treatment for complex coronary artery disease. Social determinants of health, including primary payer status, are disproportionately associated with adverse outcomes following surgical operations. We sought to examine associations between insurance status, in particular having Medicaid public insurance, and postoperative outcomes following isolated CABG surgeries.
Methods:
A retrospective review was performed using Florida, California, New York, Maryland, and Kentucky State Inpatient Databases (2007-2014) for isolated CABG patients ≥ 18 years. Multivariate regression for postsurgical inpatient mortality, postsurgical complications, 30- and 90-day readmission rates, total charges, and length of stay yielded adjusted odds ratios (ORs) reported for outcomes by insurance status.
Results:
Among 312,018 individuals, patients with Medicaid insurance and those designated as Uninsured incurred increased adjusted ORs of postsurgical inpatient mortality (56 and 64%, respectively) compared to Private Insurance. Additionally, Medicaid had the highest adjusted OR for 30-day readmission (OR 1.52, 95% CI 1.45-1.59), 90-day readmission (OR 1.53, 95% CI 1.47-1.59), postsurgical complications (OR 1.10, 95% CI 1.07-1.14) including pulmonary and infectious complications, postoperative length of stay, and total hospital charges (2016 dollars).
Conclusions:
Medicaid insurance, compared to Private Insurance, is significantly associated with worse outcomes after isolated CABG. Our results demonstrate that Medicaid as a patient's primary insurance payer is an independent predictor of perioperative risks. Further research may help explain the reasons for the differences in payer groups.
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